Intermittent Treatment Strategy Is Effective for HIV
Intermittent treatment with antiretroviral therapy (ART) in individuals with HIV is noninferior to continuous ART, according to the results of an open-label, multicenter trial.
To determine the efficacy and safety of an intermittent vs a standard, continuous, 7-day maintenance regimen of ART for patients with HIV-1, researchers from France conducted a randomized, open-label, multicenter, parallel, noninferiority trial. They randomly assigned 647 participants in a 1:1 ratio to receive either intermittent treatment, defined as therapy given 4 days weekly, or continuous treatment. Participants were recruited from 59 French hospitals and screened for eligibility from September 2017 to January 2018.
To enter the trial, participants needed a plasma viral load of less than 50 copies/mL for more than 12 months and no drug-resistance mutations against either regimen. Participants were excluded if their CD4 cell count was lower than 250/μL or if they had chronic hepatitis B virus infection.
The primary endpoint of the trial was the proportion of participants in the modified intention-to-treat population who had a plasma viral load of less than 50 copies/mL at week 48 of treatment. This population included 636 participants, or 318 per treatment group.
In this population at week 48, 96% (304 of 318) of those in the intermittent group had achieved the primary endpoint, vs 97% (308 of 318) of those in the continuous group. Moreover, improved satisfaction with daily life was reported in 59% (153 of 258) of those in the intermittent group, compared with 7% (19 of 255) of those in the continuous group. ART costs were 43% lower in the intermittent group than in the continuous group.
“Four days on and off treatment represents a workable, effective alternative strategy for patients with high adherence to ART and using a drug combination with a high genetic barrier to resistance,” the researchers concluded.
Landman R, de Truchis P, Assoumou L, et al; ANRS 170 QUATUOR study group. A 4-days-on and 3-days-off maintenance treatment strategy for adults with HIV-1 (ANRS 170 QUATUOR): a randomised, open‑label, multicentre, parallel, non-inferiority trial. Lancet HIV. 2022;9(2):e79-e90. doi:10.1016/S2352-3018(21)00300-3